ANIMAL STUDY PROTOCOL – ANNUAL REVIEW
Principal Investigator:
Date of Report
submission:
Protocol Reference #
(R-XX-XX):
Protocol
Approval Date:
Protocol Title:
1.
Please provide details of how many animals have been assigned to the study to date. Include
breeders when applicable.
Species
Total # approved
# assigned to date
Species
Total # approved
# assigned to date
Species
Total # approved
# assigned to date
Species
Total # approved
# assigned to date
Species
Total # approved
# assigned to date
2. Is this study still active? Mark an “X” in applicable box
Yes
No
Date of completion:
(Complete closure section #8 below)
3. Are there planned personnel changes to the protocol? Mark an “X” in applicable box
Yes
If Yes, has an amendment been submitted?
No
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4. Are there planned changes requested in activities under this protocol? Mark an “X” in applicable box
Yes
No
If Yes, has an amendment been submitted?
(Provide date of submission)
5. Have there been any unanticipated pain/distress that resulted in a change of pain category for
animals on this study? Mark an “X” in applicable box
Yes
New pain
category
# Animals
Describe events that led to pain category change (below)
No
6. Were there any unanticipated adverse events or mortality issues during this study? Mark an “X” in
applicable box
Yes
# Animals
Describe unexpected adverse events and/or mortality (below)
No
7. Has the location of work changed? Please include new locations and provide and updated ASP form in
a separate package in IRBnet.
Yes
No
Previous Location(s):
New Location(s):
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8. Are you closing this protocol? Mark an “X” in applicable box(es)
Yes Please indicate applicable circumstances below.
No
Work on this project is complete
Work on this project was never initiated
Work on this project was initiated but will not be completed
Principal investigator leaving/left University
If protocol will be transferred to a different PI, indicate new PI below
Approval is expiring/has expired
Will this work be continued in a renewal protocol?
Yes
No
9. If closing the protocol, and there are animals remaining in house, explain the disposition of the
remaining animals (e.g., euthanasia, transfer to other protocols or researchers, etc.):
10. Provide a brief summary of any findings, results or other relevant information.
By my submission of this document, the PI certifies that the work is being carried out in accordance with
the approved Animal Study Protocol and with the principles set forth in the Guide for the Care and Use
of Laboratory Animals. I will promptly report any changes to the Institutional Animal Care and Use
Committee.
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